About hepatopulmonary syndrome, which of the following is correct?
A. It consists of the triad of liver disease, pulmonary vascular dilatation, and a defect in oxygenation
B. Orthopnoea is a symptom but spider nevi are characteristically absent.
C. Contract echocardiography shows that the bubbles of agitated saline appears in the left cardiac chambers between the first few beats.
D. Hypoxemia almost always responds to 100% oxygen
Answer: A
The symptoms are platypnea and orthodeoxia. Spider nevi is one of the most sensitive and suggestive marker of hepatopulmonary syndrome. Bubbles of agitated saline appear in the left cardiac chambers between 4th to 6th beats because the shunt is intrapulmonary, earlier apperance suggests intracardiac shunt. Response to 100% oxygen in this condition is unpredictable.
Reference
Roberto Rodríguez-Roisin, M.D., and Michael J. Krowka, M.DHepatopulmonary Syndrome — A Liver-Induced Lung Vascular Disorder. NEJM, Volume 358:2378-2387 May 29, 2008 Number 22